Center For Health Disparities Research
The Center for Health Disparities Research (CHDR), established in October 2005 through the Academic Deans Research funding allocation, is an official center within the MUSC system. The center has built a collaborative multidisciplinary team of researchers to focus on three main priority areas including: 1) health disparities; 2) rural health; and 3) disease prevention. Specific research activities focus on chronic diseases such as cardiovascular disease, diabetes, hypertension, cancer, connective tissue diseases and mental health disorders.
Healthcare disparities are a national, regional, and institutional priority. In spite of significant advances in the diagnosis and treatment of most chronic diseases, there is evidence that racial and ethnic minorities tend to receive lower quality of care than non-minorities and that patients of minority ethnicity experience greater morbidity and mortality from various chronic diseases than non-minorities. The Institute of Medicine (IOM) report on unequal treatment concluded that “racial and ethnic disparities in healthcare exist and, because they are associated with worse outcomes in many cases, are unacceptable” . The Institute of Medicine report defined disparities in health care as “racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs preferences, and appropriateness of intervention .
U.S. Census Bureau indicates that the population of South Carolina is over 4.4 million, representing a 9.9% increase between April 2000 and July 2007 . It is also ranked among the top 20 states for projected population growth through 2030 . South Carolina suffers from a significantly high burden of chronic diseases and the morbidity and mortality associated with those diseases [3-5]. The racial/ethnic makeup of South Carolina is 68.5% Whites, 29.0% Blacks, and 3.5% are persons of Hispanic/Latino origin . South Carolina is a predominantly rural and poor state with 40-50% of the population living in rural areas and approximately 24% of the population living below the poverty line .
Consequently, it is important for our research to alleviate the burden of chronic disease in the State, and develop interventions that will foster disease prevention, reduce or eliminate healthcare disparities, and improve access and health outcomes for citizens in rural areas.
The purpose of the Center for Health Disparities Research is to bring together core faculty and develop research infrastructure to enhance competitiveness in obtaining extramural research support in health disparities research. The center will emphasize collaborative research that will build bridges across colleges on campus and across institutions within the state of South Carolina.
Partnerships will be developed with other statewide initiatives that have the potential to improve health care disparities including the Diabetes Initiative of South Carolina and the Hypertensive Initiative of South Carolina. The new center will provide an opportunity to develop a cohesive and integrated health disparities research initiative at MUSC that will diversify the current MUSC research portfolio and increase the ability of the university to compete for extramural grants and contracts from NIH, CDC, DHHS, VA, and various research foundations.
Key Areas of Research
The Center will focus on three main areas of research including: 1) primary, secondary, and tertiary prevention of chronic diseases in diverse populations; 2) interventions at the patient, provider, and health systems levels to reduce or eliminate racial/ethnic, gender, and socioeconomic differences in quality of care and health outcomes; and 3) novel interventions to improve health care delivery and health outcomes for rural dwelling residents.
Health Disparities: The Institute of Medicine (IOM) report on unequal treatment has documented that “racial and ethnic disparities in healthcare exist . The likely sources of the aforementioned disparities have been attributed to the following : (1) lack of adequate medical knowledge and information sources, (2) lack of trust and skepticism, (3) racial/cultural factors, (4) poor patient participation in healthcare decision-making, (5) clinician judgment, (6) lack of social support and resources, and (7) healthcare facility characteristics. To address existing racial/ethnic, socioeconomic, and rural/urban disparities in health outcomes we will develop and test interventions at the patient, provider, and health systems levels to reduce or eliminate racial/ethnic, rural/urban, and socioeconomic differences in quality of care and health outcomes for people with chronic diseases.
Rural Health: Determinants of health and disease differ among individuals residing in rural communities compared to urban communities including: poverty, isolation, limited access to medical services, and greater prevalence of obesity . The delivery of health care in rural areas is also influenced by the unique characteristics of rural communities such as population density, the remoteness of these communities, the characteristics of the local workforce, and the cultural norms associated with the region at large . The combination of these unique factors translates into rural-urban differences in health, disease, and disease-related outcomes. To address existing rural/urban disparities in access and health outcomes, we will develop, test, and disseminate novel interventions to improve health care delivery and health outcomes for rural dwelling residents.
Disease Prevention: Despite on going national efforts to improve quality of care for people with chronic diseases, opportunities exist for refocused approaches to better organize healthcare. One approach would involve an integrative or “tri-prevention” model of care that is organized around the natural history of most chronic diseases. Prevention programs would consist of primary, secondary, and tertiary components rather than fragmented programs with goals designed to target one specific area. To improve the overall health of the population and reduce the burden of chronic diseases, we will conduct innovative research that targets primary, secondary, and tertiary prevention of chronic diseases in diverse populations.
1. Institute of Medicine. Unequal Treatment – Confronting Racial and Ethnic Disparities in Health Care. Smedley BD et al. (Eds). National Academy Press, Washington, DC 2002.
2. Census Bureau. (2008). State and County Quick Facts: South Carolina. Retrieved March 27, 2008 from: http://quickfacts.census.gov/qfd/states/45000.htm;.
3. South Carolina Department of Health and Environmental Control. (2006). The Burden of Heart Disease and Stroke in South Carolina: Division of Cardiovascular Health. Retrieved March 27, 2008 from: http://www.scdhec.gov/cvh
4. South Carolina Department of Health and Environmental Control. (2002). South Carolina Behavior Risk Factor Surveillance System. Retrieved March 27, 2008 from: http://www.scdhec.gov/hs/epidata/brfss2002.htm#diabet.
5. Johnson, M. G., Hardy, W. R., Mosley, C. M., Andrews, V. C., & Bolick-Aldrich, S. W. (2005). South Carolina Cancer Facts and Figures 2004-2005.: South Carolina Cancer Registry, Office of Public Health Statistics and Information Services, South Carolina Department of Health and Environmental Control and the American Cancer Society.
6. Sung NS, Crowley WF, Jr., Genel M, et al. Central challenges facing the national clinical research enterprise. Jama. Mar 12 2003;289(10):1278-1287.
7. S. Saha, M. Freeman, J. Toure, K. M. Tippens, and C. Weeks, Racial and Ethnic Disparities in the VA Healthcare System: A Systematic Review. 2007, Department of Veterans Affairs. Veterans Health Administration. Health Services Research & Development: Washington.
8. J. Merchant, C. Coussens, and D. Gibert, Eds. Rebuilding the Unity of Health and the Environment in Rural America. 2006, The National Academies Press: Washington, DC.